Allergies

Allergies - About

Allergies occur when your immune system reacts to a foreign substance that typically doesn't cause a reaction in most people. In Arizona area our warm year-round climate makes us susceptible to extended allergy seasons. The Phoenix metropolitan area has been named one of the worst cities for ragweed allergies, and consistently is the top 100 worst cities to live in for allergy sufferers.

There are many different types of allergies including food allergies (for example allergies to nuts or fish), seasonal allergies (for example to tree pollen in the spring and weed pollen in the fall), pet allergies (for example to cat dander), dust mite allergies, insect sting allergies.

An allergic reaction begins in the immune system. Our immune system protects us from invading organisms that can cause illness. If you have an allergy, your immune system mistakes an otherwise harmless substance as an invader. This substance is called an allergen. The immune system overreacts to the allergen by producing Immunoglobulin E (IgE) antibodies. These antibodies travel to cells that release histamine and other chemicals, causing an allergic reaction and can inflame your skin, sinuses, airways or digestive system.

The severity of allergies varies from person to person. Allergies can cause a variety of symptoms such as a runny nose, sneezing, itching, rashes, swelling, or asthma and can range from minor to severe. Anaphylaxis (an-a-fi-LAK-sis) is a severe reaction that can be life-threatening. Doctors use skin and blood tests, along with a medical history, to diagnose allergies. While most allergies can't be cured, a number of treatments can help relieve your allergy symptoms. Treatments include medicines, allergy shots, and avoiding the substances that cause the reactions.

Allergies - Diagnosis

Your doctor or medical provider will take a medical history. You will be asked about your health, your symptoms and whether members of your family have asthma or allergies such as hay fever, hives or skin rashes like eczema. The doctor will want to know when symptoms occur, how often they happen and what seems to bring them on and will also ask about your work, home and eating habits to see if these can provide clues to help pinpoint your allergy.

Your doctor will do a physical exam and also conduct allergy tests.

Tests can be done for common allergens such as plant pollens, molds, dust mites, animal dander, insect stings and various foods such as peanuts, eggs, wheat, shellfish and milk. Testing also is available for some medicines, such as penicillin. There are two types of skin tests:

The prick test pricks the surface of the skin with a tiny amount of the allergen. The test is done on your back or the inside of your arms with several allergens tested at once. If you're allergic, redness and swelling appear at the site of the prick.

The intradermal test injects the allergen with a very fine needle under the first few layers of the skin. This type of skin test may be used when the result of a prick test is not clear.

Additionally, blood tests may also be ordered to help your medical provider discern what items you may be allergic to. Any allergy testing completed should always be used in conjunction with your medical history.

Allergies - Treatment

People can be allergic to a wide variety of substances; the most common are pollen and dust mites. Other airborne allergens include molds and animal dander.

Pollen

Seasonal allergic rhinitis, or hay fever, is an allergic response to pollen. It causes inflammation and swelling of the lining of the nose and of the protective tissue of the eyes (conjunctiva).

Symptoms include sneezing, congestion (feeling stuffy), and itchy, watery eyes. Treatment options include over-the-counter and prescription antihistamines, anti-leukotrienes, nasal steroids, and nasal cromolyn. Some people may have allergic asthma symptoms (wheezing, shortness of breath, chest tightness) caused by exposure to pollen. When symptoms are not adequately controlled with avoidance measures and medications then allergy immunotherapy treatment may be considered.

Dust mites

Dust mites are tiny organisms that live in dust and in the fibers of household objects, such as pillows, mattresses, carpet, and upholstery. Dust mites especially love warm, humid areas.

The symptoms of dust mite allergy are similar to those of pollen allergy. To help manage dust mite allergies, try using dust mite encasements (airtight plastic/polyurethane covers) over pillows, mattresses, and box springs. Also, remove carpet, or vacuum frequently with a high-efficiency filter vacuum cleaner. Treatment may include medications to control nasal/eye and chest symptoms.

Immunotherapy may be recommended for people whose symptoms are not adequately controlled with avoidance methods and medications.

Molds

Molds are tiny fungi (like Penicillium) with spores that float in the air like pollen. Mold is a common trigger for allergies. Mold can be found indoors in damp areas, such as the basement or bathroom, as well as outdoors in grass, leaf piles, hay, mulch, or under mushrooms. Mold spores reach a peak during hot, humid weather.

Treatment may include medications to control nasal/eye and chest symptoms. Immunotherapy may be recommended for people whose symptoms are not adequately controlled with avoidance and medications.

Animal dander

Allergic reactions can be caused by the proteins secreted by sweat glands in an animal's skin, which are shed in dander, and (to a lesser extent) by the proteins in an animal's saliva. Avoidance measures don't work as well as simply removing the pet from the home. However, because many people are reluctant to do this, second-best measures include keeping the pet out of the bedroom, using air cleaners with HEPA filtration (high-efficiency particulate air filters), and washing the pet (cat or dog) frequently.

Treatment may include medications to control nasal/eye and chest symptoms. Immunotherapy may be recommended for people whose symptoms are not adequately controlled with avoidance methods and medications.

Other allergens include:

Latex

Some people can develop a latex allergy after repeated contact with latex. Rubber gloves, such as those used in surgery or home cleaning, are a major source for causing this type of reaction. Skin rashes, hives, eye tearing and irritation, wheezing, and itching of the skin may occur in people with latex allergy.

Allergic reactions to latex can be mild, such as skin redness and itching. More severe reactions can occur if the mucosal membranes are exposed, such as during an operation or a dental or gynecologic exam.

Treatment of latex reactions begins by removing the offending latex product. If you have latex allergy, it is important for you to wear a Medic Alert bracelet and carry an emergency epinephrine kit. All procedures should be carried out in a "latex-safe" fashion. There is no cure for latex allergy, so the best treatment for this condition is prevention.

Food allergies.

Food allergies develop when the body develops a specific antibody to a specific food. An allergic reaction occurs within minutes of eating the food, and symptoms can be severe. In adults, the most common food allergies are shellfish, peanuts, and tree nuts; in children, it's milk, egg, soy, wheat, shellfish, peanuts, and tree nuts.

Symptoms of food allergy include itching, hives, nausea, vomiting, diarrhea, breathing difficulties, and swelling around the mouth or anaphylaxis. The gold standard for diagnosing a food allergy is an oral food challenge, which involves the person eating a food under the care and observation of a board certified allergist. Both skin (prick) and blood testing may also be used to help with the diagnosis of a food allergy, however, these tests may cause false positives and should not be used to "screen" people for food allergies.

Historically, the only treatment is to avoid the foods that cause allergy symptoms. If you (or your child) have food allergy, your doctor may prescribe injectable epinephrine (adrenaline) for you to carry at all times. This is necessary in case foods that cause allergies are accidently eaten.

Allergists are just now introducing other treatment options for food allergens, including oral food immunotherapy. This is a newer treatment and has not been FDA approved. In order to see if you are a candidate for oral immunotherapy, you must consult with a board-certified allergist.

A person may also have sensitivity to a certain food, which they may mistake as a food allergy. Food sensitivities can cause some similar symptoms to food allergies. Although there is no approved test for diagnosis, if you have a food sensitivity you may be asked to keep a food diary - and remove certain foods from your diet - to determine exactly what you're sensitive to.

An elimination diet involves removing specific foods or ingredients from your diet that you and your doctor suspect may be causing your symptoms. Your doctor will supervise this diet over a few weeks.

Insect venom (stings)

A normal reaction will result in pain, swelling, and redness around the sting site. A large, local reaction may occur that will result in swelling that extends beyond the sting site. For example, a person stung on the ankle may have swelling of the leg.

The most serious reaction to an insect sting is an allergic one, which needs immediate medical attention. Symptoms of an allergic reaction to an insect sting include:

An allergic reaction is treated with epinephrine (adrenaline). Anyone who has had a severe allergic reaction from bee stings should be seen by a board-certified allergy/immunology doctor to confirm by skin and/or blood testing that they have an allergy to bee venom. Venom immunotherapy is recommended when venom allergy is confirmed. This will help reduce the possibility that a re-sting will cause a serious reaction.

Common Treatments

The treatment for environmental allergies (pollen, mold, dust mite, and animal dander) includes combination of avoiding what you are allergic to, medications, and immunotherapy. There are many medications that can be used to help control your symptoms (which are detailed below), however, sometimes medications and avoidance measures are not enough to make you allergies tolerable.

In these instances allergy immunotherapy may be considered.

Immunotherapy injections (IT): also known as allergy shots, is a long-term treatment option for those that suffer from environmental allergies and asthma. IT can help to decrease your sensitivity to allergens, lessening your symptoms and triggers that exacerbate allergies and asthma.

A small amount of allergen serum is injected subcutaneously (under the skin). There are two phases with IT; building phase and maintenance phase. The building phase consists of weekly injections of serum that increase in strength each week and generally last 6 months depending on compliance. During the building phase you may start to notice a decrease in your allergy symptoms, but it can take as long as 12 months on maintenance dose to notice improvement. The maintenance phase occurs once a therapeutic level has been reached. The strength depends on your sensitivity and tolerance to the serum. During this phase injections are given every 2-4 weeks, which will be established by your allergist. Maintenance phase is usually continued for 3-5 years depending on the success of the treatment. The decision to discontinue IT will be made with your allergist.

There are also allergy drops (both in tablet and liquid formulations) that work using the same principle, but are placed under the tongue. Allery drops are not FDA approved and may not be covered by your insurance, so a consultation with your allergist is needed to decide on the best treatment plan for you.

Medications

Allergy medications are available as pills, liquids, inhalers, nasal sprays, eyedrops, skin creams and shots (injections). Some allergy medications are available over-the-counter, while others are available by prescription only.

Pills and liquids

Antihistamines block histamine, a symptom-causing chemical released by your immune system during an allergic reaction. Oral antihistamines, available as over-the-counter and prescription drugs, ease runny nose, itchy or watery eyes, hives, swelling, and other signs or symptoms of allergies. Because some of these drugs can cause drowsiness and fatigue, they shouldn't be taken when driving or doing other potentially dangerous activities.

Some antihistamines tend to cause drowsiness - for example Diphenhydramine (Benadryl). Others are less likely to cause drowsiness - for example Cetirizine (Zyrtec).

Nasal sprays

Antihistamine nasal sprays help relieve sneezing, itchy or runny nose, sinus congestion, and postnasal drip. Side effects of antihistamine nasal sprays may include a bitter taste, drowsiness or fatigue. Corticosteroid sprays prevent and relieve stuffiness, sneezing and runny nose. Side effects can include an unpleasant smell or taste, nasal irritation and nosebleeds. An example of a corticosteroid is Triamcinolone (Nasacort Allergy 24 Hour).

Eye drops

Antihistamine eye drops, available as over-the-counter or prescription medicines, can ease itchy, red, swollen eyes. These drops may have a combination of antihistamines and other medicines. Side effects may include headache and dry eyes.

Corticosteroid eye drops are used to relieve persistent itchy, red or watery eyes when other interventions aren't effective. A physician specializing in eye disorders (ophthalmologist) usually monitors the use of these drops because there can be a risk of vision impairment, cataracts, glaucoma and infection.

Decongestants

Oral decongestants relieve nasal and sinus congestion caused by hay fever (allergic rhinitis). Many decongestants, such as pseudoephedrine (Sudafed, Afrinol, and others), are available as over-thecounter drugs. A number of oral allergy medications contain a decongestant combined with an antihistamine. Nasal decongestant sprays and drops relieve nasal and sinus congestion if they are used for a short period of time. Repeated use of these drugs for more than three consecutive days may result in a cycle of recurring or worsening congestion.

Decongestants are used for quick, temporary relief of nasal and sinus congestion. They can cause insomnia, headache, increased blood pressure and irritability. They are not recommended for women who are pregnant or for people with high blood pressure, cardiovascular disease, glaucoma or hyperthyroidism.

Corticosteroids

Corticosteroids relieve symptoms by suppressing allergy-related inflammation. Most of these medications require a prescription and should not be used for long-term treatment of allergies.

Oral and injectable corticosteroids are used to treat severe symptoms caused by all types of allergic reactions. Long-term use can cause cataracts, osteoporosis, muscle weakness, stomach ulcers, increased blood sugar (glucose) and delayed growth in children. Oral corticosteroids can also worsen hypertension (high blood pressure).

Inhalers

Inhaled corticosteroids are often used every day as part of treatment for asthma caused or complicated by reactions to airborne allergy triggers (allergens). Side effects are generally minor and can include mouth and throat irritation and oral yeast infections. Some inhalers combine corticosteroids with other asthma medications.

Skin creams

Corticosteroid creams relieve allergic skin reactions such as itching, redness, scaling or other irritations. Some low-potency corticosteroid creams are available without a prescription, but talk to your doctor before using these drugs for more than a few weeks.

Side effects can include skin discoloration and irritation. Long-term use, especially of stronger prescription corticosteroids, can cause thinning of the skin and disruption of normal hormone levels.

Mast cell stabilizers

Mast cell stabilizers block the release of immune system chemicals that contribute to allergic reactions. These drugs are generally safe but usually need to be used for several days to reach full effect. They are usually used when antihistamines are not working or not well-tolerated.

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